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All About Trigger Point Dry Needling (TDN)

Originally published on June 28, 2011

A Brief History Of TDN

In the early 1940’s, Janet Travell, M.D. began treating myofascial trigger points (MTrP) by injecting them with analgesic medication.  The medication would then help decrease the sensitivity of the trigger point and ultimately eliminate the individual’s pain.  After further research, it was discovered that not only did the medication help provide pain relief but the mechanical stimulation of the MTrP by a needle provided immediate pain relief as well.  With the help from Dr. David Simons, Janet Travell, M.D. further developed the method of diagnosing and treating MTrP and the use of trigger point dry needling (TDN).

Since Dr. Travell’s work, several other conceptual models have been developed to further advance this treatment technique. One technique was developed by, Dr. Chan Gunn. Dr. Gunn’s model, named the “radiculopathy model”  establishes the idea that  myofascial pain syndromes or painful conditions affecting ones musculoskeletal system results from peripheral neuropathy or  radiculopathy. This occurs because the impulses traveling down the nerves are being altered due to malfunctions at it’s respective spinal levels, which then presents itself as painful or tender muscles. Dr. Gunn determined that treating the muscles  themselves as well as the muscles around their  spinal level, helped decrease pain and sensitivity. He named his treatment technique “Intramuscular Stimulation” to differentiate his philosophies from trigger point dry needling.  Today, TDN and intramuscular stimulation are used synonymously because of the similarities and history behind each technique.

What Is A Myofascial Trigger Point?

It is a hyper irritable spot, usually within a taut band of skeletal muscle or in the muscle’s fascia. The spot is painful on compression and can give rise to characteristic referred pain, tenderness and autonomic phenomena (Travell and Simons, 1992). In other words, trigger points are those areas or knots in the   muscle that can be very tender or painful when pressed or squeezed.

What Is Trigger Point Dry Needling?

Trigger point dry needling or TDN is a technique that uses small solid filament needles (acupuncture needles) to release tight muscles and/or deactivate trigger points.  This loosening or deactivation will help desensitize supersensitive structures and restore normal motion and function to the muscle.

When the needle is inserted into the muscle and through the trigger point, the muscle may involuntarily contract or twitch causing a local twitch response.  This local twitch response is the desired response to the treatment but if one does not occur, benefits can still be seen and felt.  Typically, the patient and therapist may notice a release or loosening of the muscle following a twitch response.

TDN causes a mechanical and biochemical change within the tissue, which is key to removing muscle irritation and improving healing.  This is due to a local inflammatory response, and decreasing the spontaneous electrical activity that is responsible for the development of trigger points.

It is important to understand that NO medication or fluid is injected or inserted into the skin by the needles. That is why this technique is referred to as dry needling.

Is This Treatment Considered Acupuncture?

No. The only similarities between acupuncture and TDN is the use of acupuncture needles.  Traditionally, acupuncture is a superficial treatment that focuses on restoring and improving the flow of energy throughout the body. On the other hand, TDN is directly targeting trigger points or tight muscles, which are a part of the body’s neuromuscular system.

What To Expect From TDN

  • Deep aching, cramping or pressure sensation when the needle is inserted
  • You may experience a reproduction of your pain or referral of symptoms into distant body parts
  • There may or may not be soreness following treatment. Soreness typically lasts 24-48 hours
  • It may feel as if you just completed an intense workout of the treated muscles
  • Sweating, chills, laughing, nausea, and emotional sensations are commonly seen during treatment

What To Do Following Treatment

  • Drink large quantities of water that day
  • Use heat rather than Ice
  • Stretch of do mind exercise
  • If a pain reliever is needed, use Tylenol rather than NSAID’s so that the healing response is not inhibited
  • Massage the needled areas
  • Take a hot bath or a hot tub to minimize post-treatment soreness

Who Can Perform TDN

TDN is being performed within the United States, Europe, New Zealand, and Australia by physical therapists, physicians, chiropractors and acupuncturists.

Currently, there are 18 states that include TDN within their physical therapy practice acts.

Here at Alta Physical Therapy, Charlie Merrill, MSPT has been trained and certified in the dry needling technique. Charlie has over 5 years of experience and have treated conditions that include acute sprains and strains, tendonitis, as well as back, neck, shoulder, elbow, hip and leg pain.

If you would like further information on Trigger Point Dry Needling please feel free to visit Alta Physical Therapy at www.altatherapies.com. You can access the triggerpoint dry needling information directly at

https://altatherapies.com/service/2/Trigger-Point-Dry-Needling-TDN/

or ask Charlie if TDN would work for you.

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